Provider Demographics
NPI:1942421896
Name:BARNES, WILLIE RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:RAY
Last Name:BARNES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4986 NITTANY VALLEY DR.
Mailing Address - Street 2:BOX 397
Mailing Address - City:LAMAR
Mailing Address - State:PA
Mailing Address - Zip Code:16848
Mailing Address - Country:US
Mailing Address - Phone:570-726-6748
Mailing Address - Fax:570-726-6794
Practice Address - Street 1:4986 NITTANY VALLEY DR.
Practice Address - Street 2:BOX 397
Practice Address - City:LAMAR
Practice Address - State:PA
Practice Address - Zip Code:16848
Practice Address - Country:US
Practice Address - Phone:570-726-6748
Practice Address - Fax:570-726-6794
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026736L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist